Fluoride: Best Thing Since Sliced Bread

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Fluoride Best Thing Since Sliced Bread!

• Diane Brunson, RDH, MPH
• Director, Public Health
• University of Colorado School of Dental Medicine

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Topical or Systemic?

• Both!
• Systemically in the formation of enamel, and
  incorporation into saliva throughout life
• Topically in remineralization
• Primarily topical? Think about the life of the
  tooth. In terms of time topical In terms
  of effectiveness both

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Sources of Fluoride

• Water fluoridation 1 ppm 1 mg/L
• 4.0 mg adequate daily intake (adult) (IOM-RDAs)
• 2.2 mg sodium fluoride 1 mg/L
• Provides ½ of daily recommended intake
• Other ½ from foods and beverages
• Primarily systemic
• Fluoride supplements systemic/daily
• Based on level of fluoride in water and age
• 0.25, 0.5, 1.0 mg/day to make up for water
  fluoride deficiencies

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How much water?

• 1 liter water _at_ 1 part per million to get 1 mg
  fluoride
• 1 liter 34 ounces
• Four 8-oz glasses of water to get 1 mg fluoride
• Bottom line 2 liters of water gives ½ daily
  recommended intake for adults
• Children do not consume that much water, so their
  consumption is proportional to what they need for
  adequate fluoride intake

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Sources of Fluoride

• Topical fluorides
• Weekly rinses (schools)
• 1000 ppm fluoride solution
• 2x/year in dental offices
• 4,000-12,300 ppm
• Varnish 2-4 times/year
• 22,600 ppm
• Toothpaste
• 1200-1500 ppm
• 500-1000 ppm

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Too much fluoride?

• Fluorosis is the ingestion of greater than 4mg
  fluoride daily over a long period of time
• skeletal fluorosis not seen in the U.S.
• dental fluorosis (very mild/mild) increased
  during last decade
• Cause toothpaste swallowing and improper
  supplementation
• Result Pea-sized amount of toothpaste is
  recommendation
• Not caused by fluoridation or properly applied
  topical fluorides, including varnish

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What level for toxicity?

• Acute 5-10 grams (1000 mg) sodium fluoride
  ingested at one time, which is 10,000 20,000
  times more than ingested in 8-oz glass of water
• Chronic Ingestion of over 4 parts per million
  (4 times the recommended amount) continuously
  over many years may result in skeletal fluorosis
  (no cases in the U.S.)

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Breastfeeding

• Exclusively breast fed infants may need fluoride
  supplementation beginning at 6 months.
• No rationale for giving lactating mothers
  supplements as very little fluoride comes through
  breast milk to the infant.

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Varnish Safety and Efficacy

• ADA Council on Scientific Affairs (IA)
• FV applied every 6 months effective for both
  primary and permanent dentition
• Two or more FV applications/yr effective in
  preventing caries in high risk populations
• Cochrane Review (2003)
• fluoride varnish can substantially reduce tooth
  decay in both primary teeth and permanent teeth
  (not influenced by water fluoridation or other
  fluoride sources).

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Varnish Safety and Efficacy

• Weintraub,J., et al. (2005)
• Fluoride varnish added to caregiver counseling is
  efficacious in reducing early childhood caries
  incidence.
• Am.J Prev Med (2004)
• Fair evidence for the effectiveness of two
  fluoride-based interventions (supplements and
  varnish) applicable in primary care practice.
• US Preventive Services Task Force (2006)
• The advantage of fluoride varnish over other
  topical agents include ease of use, patient
  acceptance, and reduced potential for toxicity.

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Conclusion

• Yes! Caries risk assessment
• Yes! Education of primary care giver
• Use of toothpaste strongly state not to swallow
• Yes! Fluoride varnish
• Varnish does not add to fluoride ingestion,
  therefore, does not contribute to chance of
  fluorosis

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References

• ADAs Fluoridation Facts
• http//www.ada.org/public/topics/fluoride/facts/f
  luoridation_facts.pdf
• My Waters Fluoride
• http//apps.nccd.cdc.gov/MWF/Index.asp